Conditions in the places where we live, work and play have a tremendous impact on Americans’ health. It is much easier to stay healthy when we can easily and safely walk, run or bike; when we have clean air, healthy food and access to affordable housing; and when we are safe from things like violent crime, fires and lead poisoning. Every day, policy makers in many sectors have opportunities to make choices that—if they took health into account—could help stem the growth of pressing health problems like obesity, injury, asthma and diabetes that have such a huge impact on our nation’s health care costs and on people’s quality of life.Health impact assessment (HIA) is a fast-growing field that helps policy makers take advantage of these opportunities by bringing together scientific data, health expertise and public input to identify the potential—and often overlooked—health effects of proposed new laws, regulations, projects and programs. It offers practical recommendations for ways to minimize risks and capitalize on opportunities to improve health. HIA gives federal, tribal, state and local legislators, public agencies and other decision makers the information they need to advance smarter policies today to help build safe, thriving communities tomorrow.
For example, if the HIA will address a proposal for a coal-fired power plant, what specific decision-making process (such as an air-quality permit or environmental impact statement)
such as the local economy, air quality, availability of parks and recreation facilities, or access to healthy food choices. The assessment stage can involve literature review, qualitative analysis and/or quantitative modeling. It identifies not only the important health risks and benefits, but also their distribution among vulnerable subgroups within the population (such as children, the elderly, people with chronic illnesses, racial and ethnic groups, or those with low incomes). The HIA should be conducted in an impartial, scientific way that identifies both the risks and the benefits associated with a decision. Assessment of health-related economic costs and benefits has not been common in HIA but decision makers sometimes request this information; when possible, such analysis may help them weigh the relative importance of identified health issues against other considerations.
that specifies who will implement each recommendation and how outcomes will be monitored going forward. These products should provide practical, specific actions that can be taken in order to promote health and avoid, minimize or mitigate adverse consequences.
The success of an HIA depends on effective dissemination. Simply providing recommendations is often not enough to ensure their adoption or implementation. The HIA should be conducted with an eye toward the policy levers, legal or regulatory avenues, communications and non-lobbying advocacy tactics, or other methods that will ensure effective dissemination of the findings and facilitate adoption of the recommendations. For example, in some cases when public agencies conduct an HIA, it may be possible to implement its recommendations under existing laws, policies or regulations or through the creation of new policies or regulations. In other cases, media outreach and efforts to engage, educate and build consensus among all stakeholders may be essential to ensuring that HIA insights inform key policy decisions. Reporting can take the form of memos, white papers, presentations, scholarly papers, media campaigns.
Monitoring tracks indicators that can be used to inform process, impact and outcome evaluations.
SOCIAL CONDITIONS MATTER Places where we live, work and play have a tremendous impact on American’s health Policy makers in many sectors have opportunities to make choices that—if they took health into account —could help stem the growth of pressing health problems such as obesity, injury, asthma and diabetes This is important because these issues have a huge impact on our nation’s health care costs and on people’s quality of life.
HEALTH IMPACT ASSESSMENTS look at health from a broad perspective that considers social, economic and environmental influences; brings community members, business interests and other stakeholders together, which can help build consensus; acknowledges the trade -of fs of choices under consideration and of fers decision makers comprehensive information and practical recommendations to maximize health gains and minimize adverse ef fects; puts health concerns in the context of other important factors when making a decision; and considers whether certain impacts may af fect vulnerable groups of people in dif ferent ways.
PRINCIPLES AND VALUES UNDERLYING HIA Democracy Emphasizing the right of people to participate in the formulation and decisions of proposals that affect their lives, both directly and through elected decision makers. Equity Emphasizing the desire to reduce inequity that results from avoidable differences in the health determinants and/or health status within and between different population groups. Sustainable Development Emphasizing that development meets the needs of the present generation without compromising the ability of future generations to meet their own needs Ethical Use of Evidence Emphasizing that transparent and rigorous processes are used to synthesize and interpret the evidence. Comprehensive Approach to Health Emphasizing that physical, mental, and social well -being is determined by a broad range of factors from all sectors of society
THE HIA PROCESS1 . Screening Determines whether the HIA is likely to succeed and add value. Questions include: What specific proposed project, program or policy decision will the HIA address? What will the HIA inform? How important to health is the decision? Will the HIA provide new and important information or insight on previously unrecognized health issues? Is it feasible in terms of available resources (e.g., data, time, money, stakeholder interest and political will)?
THE HIA PROCESS2. Scoping Creates objectives for the HIA , and an outline for the steps of the HIA process by asking: What health effects should the HIA address? What concerns have stakeholders expressed about the pending decision? Who will be affected by the policy or project, and how ? What methods should I use?
THE HIA PROCESS3. Assessment Involves two steps describing the baseline health of people and groups affected by the decision predicting the potential health effects. The baseline health analysis attempts to explain not only the important causes of illness, but also the conditions that influence health and could be af fected by the decision in question
THE HIA PROCESS4. Recommendations The HIA should point the way to decisions that protect and promote health. The actions required to integrate an HIA’s analysis and recommendations into a decision -making process will vary. In some cases, simply providing a thorough analysis that outlines the potential risks, benefits and costs of alternatives may help policy makers to make informed choices that support health. In many cases. However, an HIA’s ability to influence outcomes sometimes require additional efforts, including the development of specific recommendations based on the analysis, as well as a health management plan
THE HIA PROCESS5. Reporting The findings are disseminated to decision makers, af fected communities and other stakeholders with a request for feedback. This stage may result in a revised report that addresses public responses to the draft.
THE HIA PROCESS6. Monitoring and Evaluation There are three types of evaluation in HIA 1) process evaluation gauges the HIA’s quality according to established standards and the original plan for the HIA 2) impact evaluation assesses the HIA’s impact on decision - making and its success according to the objectives established during scoping 3) outcome evaluation assesses changes in health status and health determinants as the decision is implemented.
IMPORTANT TO CONSIDER WHEN CONDUCTING A HIA Think about who the key stakeholders are and involve them in the process Approach the assessment with a holistic view of health
SMALL GROUP WORK Group One: Jenny, Natalie & Kathleen Group Two: Ashley K., Sam & Leah Group Three: Bailey, Ashley N., Jef f and BillyGroup One: HousingGroup Two: New Economic Development in your CityGroup Three: Transit subsidies provided by employers